Provider Demographics
NPI:1982233094
Name:ODOM, LETTIE (MD)
Entity Type:Individual
Prefix:DR
First Name:LETTIE
Middle Name:
Last Name:ODOM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:LETTIE
Other - Middle Name:
Other - Last Name:HATTABAUGH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4301 W MARKHAM ST # 518
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72205-7101
Mailing Address - Country:US
Mailing Address - Phone:479-883-5340
Mailing Address - Fax:
Practice Address - Street 1:4301 W MARKHAM ST # 518
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72205-7101
Practice Address - Country:US
Practice Address - Phone:479-883-5340
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-02
Last Update Date:2020-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program